Minutes of the meeting 2 December 2013, 12 – 1pm, Committee Room 2, City Hall, The Queen’s Walk, More London, SE1 2AA.

Present: Boris Johnson Mayor of London (Chair) Cllr Teresa O’Neill Leader, LB Bexley Cllr Sarah Hayward Leader, LB Camden Cllr Ravi Govindia Leader, LB Wandsworth Cllr Ruth Dombey Leader, LB Sutton Dr Anne Rainsberry Regional Director (London), NHS England Dr Yvonne Doyle Regional Director (London), Public Health England Dr Jane Collins Chair, London Clinical Senate Dr Chris Streather Chief Executive Officer, South London Academic Health Sciences Network (on behalf of the 3 London AHSNs) Sir Cyril Chantler Chair, UCL Partners (Mayoral appointee) Dr Howard Freeman Chair, London-wide Clinical Commissioning Council Michèle Dix Managing Director, Planning, Transport for London (Mayoral appointee) Tim Kelsey National Director for Patients & Information, NHS England (Mayoral appointee)

Apologies Cllr Julian Bell Leader, LB Ealing Prof Sir Robert Lechler Vice–Principal (Health) & Executive Director, Kings Health Partners Academic Health Sciences Centre

In Attendance: Dame Ruth Carnall Health Advisor to the Mayor Jacob West Programme Director, London Health Commission Victoria Borwick Deputy Mayor

Welcome: The Mayor of London, Boris Johnson, thanked members of the London Health Board for their attendance and welcomed them. MINUTES

Agenda item 1 – Minutes of the last meeting

1. Minutes of the LHB meeting 16 September were agreed.

Agenda item 2 – Matters arising

The Chair invited members to raise any matters from the minutes of the meeting on 16 September and two items were raised:

- Cllr Ravi Govindia drew the board’s attention to this passage in the minutes:

  ‘Members of the Board had a number of questions about the terms of reference, scope and way in which the LHC (London Health Commission) would operate…The further developed terms of reference would be received by the Board in a few weeks.’

  He felt this did not necessarily express his understanding of what had been agreed - that there had been a commitment to bring the LHC’s Terms of Reference back to the LHB before they were finalised and that this should have been minuted.

  The Chair invited Dame Ruth Carnall to outline her understanding of what had been agreed. Dame Ruth Carnall pointed out that the LHC was an independent body but Lord Darzi, who would be leading the LHC, would want frequent updates to come to the Board. Members of the Board were referred to item 4 on their agenda where the LHC’s Programme Director, Mr Jacob West, would be presenting an update report and could be questioned about the work and governance of LHC under this item.

  Cllr Govindia concluded by saying that early sight of LHC’s ToRs would have been preferable but was reassured the LHC and the LHB would be working together cooperatively on a similar agenda. The Chair concluded the item by apologising if the LHB had not felt properly consulted.

- Cllr Teresa O’Neill drew attention to this passage in the minutes and enquired about the delay in sending the letters referred to:

  ‘NHS England Board will consider the allocation formula at its next meeting and will be aware of the support of London Health Board for the proposal to base the formula on GP registered patient lists • Health Education England are taking more time to assess a wider range of evidence before making a decision on allocation formula

• The Board agreed to write to the authors of the report to indicate support for the proposals set out in the papers.’

Cllr O’Neill was informed that the letter had been sent on the morning of this LHB meeting.

Agenda item 3 – Improving the Patient Experience

Item 3a - Background paper

The Chair invited Mr Tim Kelsey to introduce the item Improving the Patient Experience and Mr Kelsey thanked a number of board members for their contribution to this work and cited it as a good example of collaboration between the National Health Service (NHS), Greater London Authority (GLA) and London Councils. He made the following points:

• Improving the experience of people who used services was a key priority across health and care. Within the NHS, patients said that they valued their experience of care as much as clinical effectiveness and safety

• One point common to all the recent health tragedies had been a lack of a patient voice and this needed to be remedied

• The Friends and Family test across the UK had shown 75% were satisfied with the service they had experienced but that meant that 25% were not, and that presented a challenge

• Patient insight data and outcome data from the clinical context had brought about a refinement of service design and had saved lives

• Better data sharing by heart surgeons and collection of data on individual surgeons had generated honourable competition among them and had seen death rates fall by a third and 1,000 lives saved.

Mr Kelsey pointed out that nine clinical specialities were already sharing data and that more tools were being developed to take advantage of this new data with a view to not only improving patient experience but also patient care. Item 3b – Improving patient experience through transparency

Mr Kelsey told Board members that:

- No other city in the world was better placed than London to deliver ground breaking acts of greater transparency that would transform outcomes, empower patients, hold the health service to account and facilitate the means by which the NHS in England could be at the cutting edge of medical science and innovation. London could take a prominent leadership role in the UK and become a world leader in patient transparency. Although London has less than average patient satisfaction rates, that challenge also presented an opportunity that the existence of the LHB could provide leadership. Mr Kelsey sought LHB approval to take forward this work in three interdependent areas:

  - Transparency
  - Customer Service: people in control
  - Harnessing the economic and health benefits of health technology

- The second and third recommendations concerned the myhealthlondon information website. Mr Kelsey argued that patients should be seen as customers

- myhealthlondon had been involved in a series of pilots including Care Connect and involving 17 London hospitals generating hard outcome data that could be pulled together in the form of an app which would be a powerful way to modernise the Health Service. NHSE (London) is planning further investment in the development of myhealthlondon

- The third recommendation also called for the proposed myhealthlondon steering group to develop standards for good customer experience and publish a London score card. The recommendations of the Francis inquiry had yet to be implemented in this area.

The Chair offered the fare refund trigger used by Transport for London (TfL) as an analogy for good service standards.

- With regard to the fourth recommendation regarding the development of a Citizen’s Assembly Mr Kelsey saw this as an attempt to bring democracy to the NHS

- With regard to the fifth recommendation to engage the tech entrepreneurial industry, Mr Kelsey argued that there was a need for confidence in talking to industry on how best to use the data. The Chair saw this programme cohering with the MedCity programme and endorsed the release of health and social care data to enable the market to develop resources. He offered his support for all the recommendations.

Dr Chris Streather argued that a key issue was providing patients with their medical records so that medical professionals could communicate through the patient. London Connect had brought data together and the rules about data sharing needed to be tidied up.

Mr Kelsey pointed to the problem of hospitals using different identifying numbers for patients which meant that connection could not be made between different databases. The NHS number needed to be ubiquitous and hospitals should stop the proliferation of patient numbers.

Dr Howard Freeman strongly supported the transparency work of myhealthlondon and advocated its extension and for it to be rolled out nationally.

In response to a question from the Chair on how data could be accessed from the NHS, Dr Anne Rainsberry pointed out that there was a huge amount of it and Mr Kelsey responded that on mental health he’d come back to the Board with a series of suggestions about how Mental Health providers should provide data, showing the benefits of this and the NHS could be asked to develop better shared data. The Chair went on to argue for the need for some research to be done on the issue of confidentiality.

Cllr Teresa O’Neill thought transparency was an exciting agenda, the focus of which should be on how information can ensure the London health economy works better for patients. She pointed out that:

- patients being provided with medical records the consequences for groups less able to handle the data needed to be considered – for example not all eighty year olds would be in a position to use their records to challenge their doctor

- it was important for London local government to be represented on any myhealthlondon steering group, a point supported by Cllr Sarah Hayward.

Cllr Ruth Dombey strongly supported enhancing the patient voice and making services more accountable. But, she was conscious of a growing number of routes being developed for this, including Patient Participation Groups, Local Healthwatch and now the proposed NHS Citizens’ Assembly. She queried the connections between these different mechanisms and emphasised the importance of people being able to feel they were really making an impact through them. She was also nervous about the description of patients as ‘customers’ – there needed to be both a rights and responsibilities conversation with London’s citizens. Cllr Ravi Govindia:

- reminded the Board of the diversity of London’s communities which would need to be taken into consideration when considering the languages for apps

- pointed to the gap between the NHS and prison health services. Lack of communication between the two and a failure to transfer information as people came into and out of the prison system meant they were getting lost. He asked if there was any way that this project could help to address this gap. Tim Kelsey agreed that there were a number of situations where information did not flow well across the health and care systems (e.g. ambulances being unable to access people’s health records). He explained that another part of his job was to deliver the shift to digital records – with a target of a paperless NHS by 2018.

Dr Steather cited the success of coordinate-my-care which allowed an end-of-life patient to have their wishes enshrined in a care plan that could then be shared with health professionals and avoid relatives being repeatedly asked the same questions.

The Chair summed up by urging LHB to adopt all of the recommendations and asking for reports to come back to the board on myhealthlondon and the proposed conference.

**Agreed:** The Board agreed to endorse all of the report’s recommendations

**Action:** NHS England (London) to co-ordinate work to take forward agreed actions.

**Agenda Item 4 – Update on the London Health Commission**

Mr Jacob West, Programme Director, London Health Commission (LHC) introduced the report stating:

- It provided an update on the finalised scope, timeframes and governance of the (LHC)

- The first meeting of the commission would take place immediately after the meeting of LHB

- There were many substantial challenges in London ranging from the late diagnosis of cancer to the fact that one in five children in London was at risk of obesity • The commission would bring together the NHS, the public and industry

• The Commission, chaired by Professor the Lord Ara Darzi, would begin with the publication of the scope and the “Call for Evidence” – an invitation for stakeholders from within and beyond London to start to get involved in the debate. The Call for Evidence would focus on four main themes: o Improving the quality and integration of care o Enabling high quality and integrated care delivery o Healthy lives and reducing health inequalities o Health economy, research and education

• The final report, which would make recommendations about the future of health and healthcare in London in each of these areas, would be published in summer/autumn 2014.

The Chair invited members of the LHB to comment.

Cllr Govindia said that it would have been useful to know the budget of the commission and who were contributors. Mr West explained that the budget had not yet been announced and Dr Anne Rainsberry informed members that it would be in the public domain by the end of the week.

**Action:** The Chair agreed a note would be sent to the Board regarding the funding of the London Health Commission.

Cllr Sarah Hayward asked who would sit on the ‘four expert groups’. Mr West responded that the experts would be drawn from London, the UK and internationally and any ideas for whom to appoint would be welcome.

Mr Kelsey argued that a reason previous reviews had not delivered the changes needed was too strong a focus on the supply side. He felt many patients were undemanding, even passive in relation to their health services and an important part of the challenge was how to activate people, who were the best drivers for change.

Mr West saw the Healthy Lives programme as a way of developing that approach. Mayor Johnson was concerned that there was a risk of merely stirring up anxiety. Mr Kelsey responded by saying that it was a question of giving people the confidence to demand good services.

Dr Yvonne Doyle assured the LHB that a strong local government input into the London Health Commission was sought. Agreed; The LHB agreed to note the:

- final scope of the London Health Commission
- timescales and reporting arrangements for the Commission.

Agenda Item 5 – Mental Health

Dr Yvonne Doyle introduced the item and thanked Dr Paul Plant, author of the report and Ms Gillian Norton, Chief Executive of the London Borough of Richmond-upon-Thames for her contribution. Dr Doyle went on to say that the report:

- Recommended that the LHB championed an ambitious approach to improving the mental health of Londoners by building on the excellent work evident in many parts of London, with its role focused on:

  - Leadership
  - Setting pace and ensuring scale and fidelity to what will work in London
  - Aligning resources
  - Respecting difference and diversity of local approaches
  - Simplifying the answer to ‘what do we do to promote mental health?’

- Specifically the Board was asked to support an approach that:

  - Championed the roll out of digital support to all 6m Londoners aged 16 plus to maintain and improve their mental health.
  - Championed work with adolescents to improve their resilience, thereby increasing their mental health and improving education outcomes and reducing offending levels.
  - Championed the development of more effective support to ensure talent was not lost from the London workforce due to people falling out of employment or not getting a job because of their mental illness.

- This was an approach that enabled people on the verge of poor mental health to get upstream of it before the damage was done and fostered self-management. It tried to keep people at work which was not only good for productivity and competitiveness and thus helped the London economy but improved mental health, reducing offending and improving education outcomes; • These priorities had the support of the London Health Chief Officers Group and a wider group specifically looking at the potential role of the LHB in promoting mental health led by Gillian Norton and had representation from key partner organisations and professional groups

• On the health at work agenda local government was being looked at to champion it.

The Chair asked how it was to be paid for. Dr Doyle explained that the Board’s championing of this work would provide an impetus for many interested parties to work together and act as a coalition, sharing good practice and aligning their actions and resources to greater effect than they would get working alone. The Chair queried whether the costs of taking action would all fall on boroughs. Dr Doyle explained that some costs would, where boroughs chose to act in relation to their responsibilities e.g. 19 boroughs were either committed to, or thinking about, the self-help/care agenda already. But others would also have resources and roles in making things happen, e.g. the Academic Health Science Networks were also developing work in this area.

Dr Jane Collins stressed the need to ensure work was joined up and enthusiasm was generated across mental health. She also asked about the need to target work at under 5s as well, given the evidence that if interventions happen really early in life you get better results. Dr Doyle responded by saying that an enormous amount of work was going on under 5s health, the health visiting agenda and Troubled Families. The proposals before the Board had been targeted in the areas where stakeholders felt that there was a real potential for the LHB to add value to what is already happening.

The Chair pointed out that the police often felt that they were the body required to deal with mental health problems and Dr Doyle thought that the work on adolescents of the London Crime Reduction Board would feed into the LHB work.

Ms Michelle Dix mentioned the linkages to the work of the LHB on mental health and the benefits of promoting physical activity and ensure work was joined up. She also mentioned the importance of walking and cycling.

Sir Cyril Chantler pointed out that mental health was the commonest of all illnesses and could be influenced before a child was born. Energy needed to come from beyond health professionals, from adolescents helping each other in communities and from councils’ social services departments.

The Chair asked whether there was anything that the LHB could do to make a 16 year-old more likely to use a mental health app. Dr Anne Rainsberry cited the Big White Wall, online support for mental health and also put down a challenge about what the products/deliverables of this work the Board should expect. Dr Doyle pointed out that there was a good deal of detail in the report and cautioned that the LHB could not always require but could encourage.

Dr Chris Streather argued that the three aspects that the Board was being asked to support were in fact inextricably joined up and mentioned the work of Dr Matthew Patrick, Chief Executive of South London and Maudsley NHS and Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health (or the Mental Health Tsar).

**Agreed**

LHB agreed to endorse the report’s recommendations

The Chair wound up by saying that the common theme that had come out of discussions on transparency and mental health was the need to engage and empower people, and the potential of new technology, in particular apps, to support this. The LHB agreed the recommendations on mental health detailed above.

The meeting ended at 12:55 pm